The foundation of expertise and creative innovation at The Rybar Group begins with our people. Multidisciplinary in composition, they collectively hold over 150 years of hands-on management in the healthcare financial, revenue cycle, compliance, provider and payor experience.

RONALD K. RYBAR, FHFMA, CMPA

As the Founder and President of The Rybar Group, Ron offers over thirty-five (35) years of experience in healthcare financial management to our clients. Ron began his career working in the Finance department of various Michigan hospitals, before becoming a consultant with a national public accounting firm, focusing on healthcare clients. He formed The Rybar Group in 1989 with the mission to provide quality service to healthcare management, while assisting them in maintaining financial viability through compliant, efficient business operations. He has spent the past twenty-six (26) years leading The Rybar Group in becoming a nationally recognized premier healthcare consulting firm.

Over the years, Ron has worked with providers nationwide on engagements related to financial performance, payment optimization, data integrity and compliance with federal and third-party payor regulations. Ron’s successes include:

Provided litigation support for a variety of providers and provided testimony in Federal District Court as an expert witness.

Additional achievements and activities include numerous Interim Chief Financial Officer engagements, cost report preparation, reimbursement and revenue estimating studies for hospitals, home health agencies, hospices and SNFs, and the completion of numerous strategic pricing analyses and feasibility studies for health-related facilities. He has assisted in corporate reorganization, establishment and set-up of new corporate entities, and provided financial training for corporate board members.

In addition to his activities, Ron is an active member of the Great Lakes Chapter of Healthcare Financial Management Association (HFMA). He has held numerous positions within the association, including Chapter President, served in National HFMA positions including Chapter Liaison Representative and on the National Advisory Committee (NAC), and presented at the ANI conference. Ron also served on the Small and Rural Hospital Council for the Michigan Health and Hospital Association. Currently, Ron serves on the Audit Committee of a Not-for-Profit hospital, which is part of a national corporation and on the Finance Committee of a mid-sized HMO.

Ron received his Masters in Business Administration from the University of Detroit, and a Bachelor of Arts degree in Economics and Political Science from Kalamazoo College.

CLAUDINE HILDRETH

For over thirty years, Claudine has been working in various aspects of the healthcare industry, focusing on internal business relations and on providing exceptional client relations. She has worked in a variety of positions within the hospital, clinical office and pharmaceutical distribution settings. As The Rybar Group’s Director of Client Relations and Business Development, Claudine’s primary role is to work as the business liaison of the organization, focusing on the success, satisfaction and growth of our clients.

Over the years, Claudine has lead a number of organizations through restructure and change, developing strategies to ensure stability while creating a new framework and plan for growth. She has proven experience in directing business efforts, working to align resources and services to meet the needs of organizations.

Prior to joining The Rybar Group, Claudine accumulated a broad range of expertise in a variety of corporate areas. This expertise includes:

Business Operations and Management

Vendor Relations

Project Management

Strategic Relations

Customer Satisfaction

Sales and Marketing

Training and Development

Product Development and Launch

Recruitment and Retention

Contract Analysis, Negotiations and Performance

Purchasing

Administration

Accounting

Strategic Planning

Business Strategies Development

Claudine graduated with a Bachelor of Arts degree in Communications from Michigan State University, with a minor in Animal Science and Pre-Veterinary Medicine.

RICHARD S. REID, MPA, FHFMA, CPA

As Director of Provider Payment Analytics, Rick offers our clients expertise in the healthcare financial and reimbursement service areas. His expertise covers a wide range of strategic initiatives centered on the complexities of reimbursement and payment for all provider types; including specialization in ensuring rural health providers are optimizing their opportunities.

Rick has worked in a variety of roles in finance departments, including multiple years as a Chief Financial Officer for Acute Care and Rural hospitals, as well as having worked as a consultant for multiple national healthcare consulting firms and for a healthcare payor. Rick’s work was acknowledged when he became the recipient of the 2013 North Bay CFO of the Year Award for his work in Northern California.

Having worked within numerous health systems and hospitals nationwide, Rick has developed a strong understanding of both present and future reimbursement and payment issues and proactively develops strategies to ensure providers are optimizing their opportunities. He offers an in-depth knowledge of accounting, budgeting, reimbursement and revenue cycle functions, including Medicare and Medicaid Cost Reporting, Third-Party Reimbursement, Contractual Modeling, Corporate Compliance, Strategic Planning, Financial Analysis, Budgeting, Decision Support and Payor Reimbursement Systems. His accomplishments include:

Increased both reimbursement and operational efficiencies through implementation of operational strategies.

Implemented 340b pharmacy programs at rural hospitals. One such program resulted in increased reimbursement of over $700,000 and reduced drug expense of over $1 million annually.

Worked with a community hospital in developing processes to improve net reimbursement, taking advantage of State programs designed for District Hospitals. Annual reimbursement impact over $2.5 million.

Successfully merged a new physician practice into the hospital and moved procedures from the office to the hospital resulting in $400,000 of additional reimbursement.

Reduced Accounts Receivable of a hospital by over 24.3 million dollars / 28.8% and increased net revenue by over 2.5 million dollars in first 4 months and maintained the reduction.

Revised the Medicaid application process flow to ensure capture of all potential Medicaid patients at a large urban hospital. Estimated annual increase of 40 million dollars.

Revised an urban hospital’s contractual model, bringing over six millions dollars in additional reimbursement and revised prior cost reports resulting in an additional eight million dollars in reimbursement.

Key role in identifying and implementing operational improvements for a rural hospital, resulting in increased reimbursement and reduced costs of over a combined total of $1.6 million in a six-month time period.

Rick received his Bachelors degree in Accounting and his Masters in Public Administration degree from Western Michigan University. He is an active member of the Western Michigan Chapter of the Healthcare Financial Management Association, having served as the Chapter Treasurer and as a member of the Board. In addition, he is a member of the American Institute of Certified Public Accountants, Michigan Association of Certified Public Accountants and the American College of Healthcare Executives.

JULIE HARDY, MSA, RHIA, CCS, CCS-P

Julie offers the clients of The Rybar Group a range of expertise in the area of Professional Service Documentation, Coding and Reimbursement in both the ambulatory and inpatient settings. As the Director of Physician Services in our Data Integrity and Compliance Department, Julie brings over ten years of results-driven leadership experience and a high level of technical knowledge to the clients ranging from primary care to a variety of surgical specialties and nearly everything in between.

Julie has worked as a Professional Coding and Documentation Auditor and Educator for a variety of provider types, including private practices, teaching facilities, and hospital based practices, in several states and with a variety of payers. Julie’s experience includes coding inpatient, outpatient and surgical procedures. By partnering with physicians and their staff, Julie assists with documentation needs, including providing training on how to apply coding and reimbursement guidelines to documentation, how to simplify documentation to meet both clinical and coding needs, appropriate coding practices and ways to achieve optimal reimbursement and compliance. She is well-versed in teaching physician guidelines, billing for Advanced Practice Providers (APPs), and incident to requirements, as well as performing audits to assess for compliance with all applicable guidelines and regulations and for reimbursement opportunities.

With experience in a range of settings and organizations, Julie applies that knowledge for process improvement, compliant reimbursement enhancement and provider education. Having worked extensively in the daily functions of professional revenue cycle, Julie has a strong understanding of the needs and challenges related to professional reimbursement and strives to help providers and their staff streamline processes to ensure that the workflow is efficient and that payments are being optimized. She has helped develop policies and procedures related to coding, documentation and auditing, as well as designed and created documentation templates for efficient coding and billing processes.

Julie’s past experiences include:

Overseeing the front- and back-end revenue cycle functions for a multi-hospital health system.

Decreased coding backlog for a large integrated care delivery system by 70% utilizing Lean methodologies for production.

Served as the process owner for a multi-departmental improvement opportunity that reduced billing turnaround from 150 days to 40 days.

Identified revenue opportunities for a facility-based urgent care center leading to an additional $1 million in annual charges.

Partner with physician executives to lead documentation improvement efforts for multiple hospitals and clinics.

Performed analyses for provider-based billing for on- and off-campus sites.

Served as the ICD-10 implementation lead for a professional coding department.

Established and monitored KPIs for professional revenue cycle during an Epic implementation to ensure timely filing and collections for a multi-hospital health system..

Served as a Superuser for Epic implementations in the revenue cycle setting for three hospitals.

Julie holds a Masters of Healthcare Administration from Central Michigan University and earned her bachelor’s degree in Healthcare Management and Medical Records Administration from Ferris State University. She is a member of the American Health Information Management Association, the American College of Healthcare Executives, the Medical Group Management Association and the Healthcare Financial Management Association.Download PDF Bio

JAMES L. HEDGES, CPA, CIAP-T, MSCIS

Serving as the lead of The Rybar Group’s Blue Cross Reimbursement service line, Jim offers our clients over twenty-four years of financial healthcare experience. His extensive knowledge of payor reimbursement systems, including Blue Cross Blue Shield of Michigan, is continually in high demand.

Jim is recognized as an expert in the Michigan hospital reimbursement community on the Blue Cross Front Sheets, the underlying claims data, and how they are reimbursed through the settlement process. He has performed cost report audits for hospitals of various sizes, from Peer Group 5 hospitals to multiple hospital health systems. Jim focuses on the technical aspects of the Blue Cross Model, positioning clients to identify both present and future opportunities. He specializes in claims related Blue Cross audits, working with facilities to ensure correct payments. Using 835 files, Jim has developed Blue Cross Payment Validation, which helps hospitals see their current cash position with Blue Cross, validate their contractual model and provides logs, including for outpatient.

In addition, Jim has worked to ensure that Blue Cross projects such as e-Prescribing, e-Registration, and e-Enrollment complied with applicable laws such as HIPAA Privacy and Security, Medicare, and other regulations. He has analyzed claims data for data integrity issues and compliance with payor regulations to ensure proper reimbursement and has used data mining to validate and test third-party settlements to ensure compliance to contract.

Jim is a Certified Information Assurance Professional with Trainer endorsement and was among the first people in the country to pass the BS7799 (now ISO 27001) Lead Auditor exam. He has served as a university instructor, teaching both graduate and undergraduate level courses. Jim is a member of the Healthcare Financial Management Association.

Jim holds a Master of Science Degree from the University of Detroit Mercy.

GREGORY L. MURRAY, MBA

Greg has over twenty-five (25) years of experience as a healthcare financial management professional, working in several large Michigan hospitals. He offers our clients innovative problem solving capabilities and the ability to link business strategies to successful outcomes.

Greg has served as the Director of Financial Planning for a large multi-hospital healthcare system with responsibilities for reimbursement, operating & capital budgeting, and financial analysis. As a Financial Consultant for a joint venture Radiation Oncology Center, his involvement included start-up, obtaining bond financing, and managing financial operations. In addition, he has served as a financial consultant for a successful low income county health plan, developing financial systems and, acting as the Chief Financial Officer.

Over the years, Greg has managed and directed the financial operations for both the Home Health & Hospice and Durable Medical Equipment companies within a large healthcare system with responsibilities for revenue cycle, cost reports, contractual allowances, budgeting, analysis and compliance. He developed, implemented and directed a system-wide corporate compliance program for a large healthcare system, including multiple joint ventures. This included developing and implementing compliance policies, HIPAA privacy regulations and EMTALA, reviewing physician contracts for compliance, administering healthcare system educational program and preparing annual compliance reports for the Board and Corporate Office. Greg was involved in the merger and closing of four hospitals, the opening of a new medical center, and the formation of a new healthcare system.

Greg is currently a member of the Health Financial Management Association (HFMA) and the Health Care Compliance Association. He is a former recipient of the Follmer & Reeves Award from HFMA.

STEPHEN C. SPRAGUE, CPA

Stephen has over twelve (12) years of experience working in financial analyst positions across multiple markets. During this time, he has developed an expertise in all facets of accounting, including corporate budgeting, financial reconciliations, and financial reporting. His experience includes multiple years as a Corporate Controller for a national business strategy organization.

Additionally, Stephen’s previous experience includes working as an auditor of a large regional accounting and business consulting firm, focusing on audits, financial statements and other assurance services for clients in a variety of industries. He also worked as an Internal Controls Analyst, focusing on obtaining quarterly certification of financial results and internal controls in accordance with the Sarbanes-Oxley Act of 2002, coordinating, testing and remediating deficiencies identified, and assisting in the approval of programs as qualified restructuring expenses. Stephen has managed several special projects over the years, including the conversion of an accounting system.

Currently, Stephen serves as a consultant on our Rural Health/Critical Access Hospital Division. Stephen has worked with numerous rural hospitals, and performed analysis and conversions for Rural Health Clinics and hospital departments seeing Provider-Based status. He works with these facilities to ensure that they are optimizing reimbursement under their special designation.

Stephens’s accomplishments include cost report preparation, cost report review, filing of appeals, third-party audits, preparation of reports, and special payment requests filed with third-party payors. He has prepared monthly financial statements and audit workpapers, variance analysis, and participated in special projects involving due diligence work, such as mergers and acquisitions. Stephen has also completed mediation on numerous Provider Reimbursement Revie Board (PRRB) cases.

Stephen’s experience also included working as a consultant on our Volume Decrease payment (VDP) Adjustment team, working with hospitals nationwide to take advantage of this reimbursement opportunity. He has participated in the completion of VDP request for Sole Community and Medicare Dependent Hospitals and cost report structure reviews to ensure all reimbursement opportunities are optimized.

Stephen holds a Masters of Accounting degree from the University of Michigan and is a current member of the Great Lakes Chapter of Healthcare Financial Management Association.

DEBORAH WILEY-CROSSEN, CPA

Deborah has over thirty-four (34) years of financial management, reimbursement and compliance, revenue cycle and operations expertise. She has held executive level positions of Vice President, Chief Financial Officer for a post-acute care division of a national Catholic integrated health system; Director of Reimbursement and Director of Special Projects for an Academic Medical Center, and has worked for Big Four accounting firms.

Deborah’s past experience covers a broad range of accomplishments. Highlights of these include:

Member of a senior management team responsible for the implementation of a competitive plan that enhanced patient care, streamlined services, consolidated facilities, relocated two hospitals and resulted in significant reduction of system costs.

Captured and analyzed cost data for a nationally recognized academic medical center, identifying opportunities to manage costs. Integral team member in developing operational benchmarks and targets.

Responsible for developing and managing a corporate reimbursement and revenue enhancement department to provide direction to seven hospital subsidiaries and a nursing home.

Assisted hospitals in preparing and submitting information required for State DSH audits.

Provided reimbursement and revenue cycle consulting to urban and rural hospitals as well as home health agencies and an infusion therapy company.

Provided litigation support to national law firms as part of a multi-million dollar Qui Tam defense for a multi-state home health organization and hospital based skilled nursing unit, resulting in considerable savings to both organizations.

Performed reimbursement analysis and determined the financial impact of all claims audits performed for home health agencies, rural health clinics, multi-specialty group practices, inpatient psychiatric hospitals and physician home visiting companies.

Deborah currently is an adjunct professor in the Master of Health Services Administration program at the University of Detroit Mercy where she teaches various health care accounting, finance and economics classes.

In addition to her activities, Deborah is an active member of the Eastern Michigan Chapter of Healthcare Financial Management Association (HFMA). She has held the past positions of Chapter President; Treasurer; Secretary and served on several committees.She is also a member of the Michigan Association of Certified Public Accountants.

Deborah received her Master’s degree in Health Care Administration and a Bachelors of Business Administration in Accounting from the University of Toledo.

JENNIFER ISHMAEL, RHIA

Jennifer offers the clients of The Rybar Group a range of expertise in the areas of professional and facility coding, auditing and education, process improvement, as well as project management. As a member of our Data Integrity and Compliance team, Jennifer has worked with multiple specialties, ranging from primary care to diagnostic radiology, and several additional specialties in between, as well as with various hospital outpatient departments.

Jennifer’s accomplishments include:

Performed audits, focusing on the identification of compliance related issues as well as potential reimbursement opportunities. Focused audits in the areas of:

Computer Assisted Coding (CAC) for accuracy and appropriate parameter set-up to ensure coding was captured appropriately based on applicable guidelines.

Work on audits and reports as the Independent Review Organization (IRO) for providers under Corporate Integrity Agreements (CIA), initiated by the OIG.

Review of production coding work to help ensure quality and consistency for our clients who are utilizing outsourced options to eliminate backlog coding work.

Assessment of policies and procedures for validity, accuracy, efficiency, and compliance with any applicable rules and/or regulations.

Active member of a work group centered on the preparation and successful implementation of ICD-10 coding.

Development of clinical documentation prompting templates based on the level of increased specificity necessary for ICD-10-CM.

Creation of a user friendly and comprehensive audit tool for an Inpatient Psychiatric Medical Necessity audit based not only on the service type but also on the individual payer.

Assistance in the development of a Health Information Management (HIM) staffing assessment tool, designed to accommodate facilities of any size or type.

In addition, Jennifer has worked with a variety of EMR systems, including EPIC, CPSI, and Meditech.

Jennifer received her Associates in Health Information Technology from Baker College, and holds her RHIT. She is currently working on her Bachelors of Health Information Management through the University of Cincinnati, with plans to sit for the RHIA in the near future. She is an active member of the American Health Information Management Association (AHIMA) as well as with the Michigan chapter (MHIMA).

TAMRA RAAB

Tammy currently serves as a Reimbursement Analyst on our Provider Reimbursement and Analytics team, working with hospitals of various designations to assist them in optimizing their reimbursement and payment opportunities. Her focus includes work with contractual reviews, Blue Cross Blue Shield Revenue Strategies, and Governmental and third-party appeals and reopens.

Over the past four years, Tammy has been assisting the clients of The Rybar Group with various Medicare related appeal opportunities. She has developed an expertise in providing reimbursement, financial and data analysis related services.

Tammy served as a Support Specialist for our Volume Decrease Payment (VDP) Team, assisting hospitals nationwide to take advantage of this reimbursement opportunity. This included work on VDP requests for Sole Community and Medicare Dependent Hospitals. In addition, she worked on client third-party appeals and cost report structure reviews to ensure all reimbursement opportunities were optimized. Along with the VDP consultant team, Tammy focused on identifying improved reimbursement opportunities for our clients.

As part of her activities, Tammy worked on not only compiling the necessary data and documentation for the appeals, but also performed analytics on the information based on the regulatory requirements. She served as a point person, following up on the appeals with the Medicare Administrative Contractors, and communicating needs to the clients. She collected and analyzed various benchmark data from the hospitals on a monthly basis, analyzing the information for additional appeal opportunities. Through the appeal process, Tammy worked on various components and worksheets of the cost reports. In addition, Tammy developed and implemented numerous processes to streamline the appeal process and tools that could be used by the clients for reporting purposes.

Tammy holds a Bachelor of Science in Accounting Fraud from Davenport University.

KIMBERLY SMITH, MSITM

Bio coming soon

CAREN PUVALOWSKI, CHFP

As the Service Line Leader in our Critical Access Hospital/Rural Health Division, Caren offers our clients over twenty-three years of CAH and other Rural Hospital financial, accounting revenue cycle and reimbursement experience. She has worked in a variety of roles in the finance departments of Critical Access Hospitals (CAHs), including multiple years as a Chief Financial Officer. Caren’s prior provider experience and hands-on knowledge of the issues impacting rural hospitals allows her to identify both present and future reimbursement and payment opportunities.

Caren’s broad experience in multiple facilities has included ensuring that they optimize their payments under their CAH and rural designations. Areas of focus have included financial, reimbursement, cash flow analysis, pro-forma scenarios, accounting, general ledger, financial statements, contractual allowance, contract management and negotiations, operational efficiency, and revenue cycle analysis. Caren brings these areas of focus to effectively assist our clients. Her accomplishments include:

Successful application submission and conversion of a hospital to CAH status, as well as several clinics to Rural Health Clinic status.

Negotiation and coordination of payer contracts, including those for a new retail pharmacy.
As CFO for a CAH, consistently established a culture related to overall financial performance and worked as a leader to sustain a fully operational community hospital

Lead cross functional teams focused on various initiatives including the reduction of lost revenue, risk management, internal policies, risk of claims and other and revenue cycle related areas.

Key role in development of community support and fundraising activities in an effort to ensure that the hospital remained open and solvent. Activities exceeded the identified goal.

Oversight of the reporting of the Meaningful Use attestation stages which resulted in additional revenue for the hospital.

Lead role in the implementation of a new financial system while enhancing processes to increase charge capture, reduce claim errors and improve accuracy. Experience with a number of financial and EHR systems, including Dairyland/Healthland, Rollins, Tech Time/MedWorxs, HMS and Epic.

Multiple employee and board presentations, as well as annual open community meetings.

Caren earned a Bachelor of Business Administration degree from Saginaw Valley State University, majoring in Finance. She is a member of the Great Lakes Chapter of Healthcare Financial Management Association and has achieved the status of Certified Healthcare Financial Professional. In addition, she completed the World Class Customer Service with Innovation course through Dale Carnegie.

MARISA ELLIOTT, CPC, CDEO, CHONC, RH-CBS, AAPC FELLOW

As a Fellow of the American Academy of Professional Coders, Marisa offers a range of expertise in the area of professional service revenue cycle management, coding, auditing and education. She has spent the past sixteen years working in a variety of settings as a manager, a coder and as an educator. Having worked in all aspects of the revenue cycle, Marisa is able to apply a critical eye and mind to projects.

Marisa has experience working with a multitude of specialties, including cardiology, plastic surgery, hematology/oncology, orthopedics, trauma, rural health clinics and general surgery, in addition to evaluation and management in all specialties. She is a certified Hematology and Oncology coder (CHONC), a Rural Health Coding and Billing Specialist (RH-CBS), and has experience working in tribal health reimbursement. In addition, she is a Certified Documentation Expert Outpatient (CDEO).

Utilizing her knowledge, Marisa assists both providers and coders in maintaining data integrity, in optimizing reimbursement and payment opportunities and in ensuring compliance. Her recent activities have focused on documentation improvement with physicians and Advanced Practice Professionals (APPs), and on providing coding/billing guidelines and documentation improvement education to a residency program. She is experienced in training on ICD-10 changes and guidelines, HCC and risk adjustment, and has assisted in the development of a care management program. Marisa has assisted practices in obtaining Patient Center Medical Home (PCMH) designation and in completing HIPAA and compliance training. Marisa’s additional experience includes:

Key role in the implementation of Electronic Medical Records. Activities included the management of and creation of physician documentation templates for a streamlined transition, and assisting with diagnosis code capture and front-end edits. Worked on practice transformation during the EHR transition, serving as a super user and an application expert on athenaCollector®.

Decreased days in accounts receivable for professional services with focus on compliance of timely documentation policies, coding capture and submission, and implementation of standardized workflow for aging A/R.

Assisted in the implementation of patient self-service software for a streamlined check-in process, as well as an application for physicians to simplify clinical workflow in Inpatient, Outpatient, and Surgical settings and to ensure charge capture.

Ongoing audits to verify risk analysis within the revenue cycle on both coding and documentation and back end edits, ensuring timely turnaround. Audit activities for one Emergency Department identified deficiencies in coding that aided in the capture of $500,000 in net collection.

Participated in and lead compliance and risk task groups to ensure proper auditing and education according to the then current OIG work plan. Co-created an electronic audit tool to standardize score cards, education, and timelines.

Created and maintained weekly regional update and compliance webinars, eligible for CEU’s.

Marisa has experience working with a variety of systems in the revenue cycle arena, in a coding/billing capacity and clinical documentation including AllscriptsTM, Epic, eClinicalWorks, RPMS, and athenaCollector®.

Marisa is a member of the American Academy of Professional Coders (AAPC), Michigan Medical Billers Association (MMBA), and the Association for Rural & Community Health Professional Coding (ARHPC). She chairs events for the Eastern Chapter of MMBA and serves as a speaker for chapters throughout the state on their behalf.

ERIC STEC, CPA

Eric has spent the past several years working as a senior-level accounting professional, focusing in the areas of tax and audit across multiple markets. During this time, he has developed an expertise in all facets of accounting, including corporate budgeting, financial reconciliations, and financial reporting.

Currently Eric serves as a Reimbursement Analyst on our Provider Reimbursement and Analytics team, working with hospitals of various designations to assist them in optimizing their reimbursement and payment opportunities. His focus includes work with contractual reviews, Cost Report Strategies, and Governmental and third-party appeals and reopens.

Eric holds a Bachelor of Science in Accounting from Ferris State University.

The Rybar Group is an independent member of the BDO Alliance USA, a
nationwide association of independently owned local and regional accounting,
consulting and service firms with similar client goals.